When Corporations
Rule the World
By Karen Simonton
"Unfortunately, in our modern world, control seldom rests with local people.
More often it resides either with central governmental bureaucracies or with
distant corporations that lack both the capacity and the incentive to deal
with local needs." When Corporations Rule the World
I recently sat in on one of my partner’s Medical Staff presentations. With his local medical brethren, he was sharing an opportunity for physicians to reclaim their rightful positions as captains of the medical ship. Over the last year, he has been subjected to countless 6:00 am and 6:00 pm meetings, as well as homework, to become educated on how physicians regain their position at the helm as healthcare sets its course on the Accountable Care Sea. Likewise, his entrepreneurial partners subject themselves to similar time encroachments. An endless stream of meetings, all happening before or after patient care, to include:
- Hospital administrators – addressing service line management and other business ventures
- Payers – addressing bundles, fee schedule reductions, profiling, impediments to cost reduction strategies, contract terms, outcomes
- Legislators – addressing assignment of benefits, threats to the provision of integrated medical services (state and federal), workers compensation reforms, insurance diversification, healthcare reform (we are providers and employers in that world)
- Employers – addressing insurance participation, workers compensation, direct contracting
- Their own C Suite Team – addressing going concern topics, personnel, compliance, etc.
- As well as all the clinically relevant meetings that all physicians attend as part of their attention to patient care.
This is independent medical practice, full of missed dance recitals and family dinners, endless days working to balance the acuity of individual patient needs with the chronic issue of better population health, all the while running a real business supporting the lives of hundreds of employees and their families and the tax base of the communities in which we practice (we pay all the personal property, real estate and BPOL taxes that non-profits escape).
Returning to that meeting, my partner finished his presentation and opened the floor for questions. One of the questions was, “If I invest in (own) this, HOW much money will I make?” This is not particularly surprising as, in my humble opinion, physicians have largely become piece workers wedged between the interests of large hospital systems (often headquartered in other states) and even larger payers (again not of the Commonwealth). Because we know the human condition will require healthcare services forever, the real question is, “WHO will direct the provision and payment for healthcare services?” It should be the local expert who has the education and experience, who is the only person who knows the patient intimately, who invests in the community personally and financially, and who understands the financial concerns of patients because he has to make similar decisions for the business he owns.
Administrators, of which I am one, and physicians, with whom I have shared my professional life, must plug in and recharge so that we are all fueled with the requisite curiosity and drive to manage our community’s future from our own front yard. It is misguided to assume others will meet with legislators and lobbyists to protect our roles as medical stewards of the community. It is misguided to assume that the payer’s interest in the subscriber’s well being will somehow trickle down to the physician, who ultimately takes care of the patient. It is misguided to assume that someone whose focus is on the nation (Congress, UHC, Anthem, Cigna, HCA, <insert any other national healthcare player here>) will be the best resource to look after the needs of your local community. VOS is working in conjunction with several other medical advocacy groups and a small group of orthopaedic administrators to ignite the flame for private physician practice advocacy. As a member of a national orthopaedic forum, I love to hear the stories of orthopaedic society wins for physicians (like Florida where assignment of benefits was upheld and signed into law by the governor). Let us recommit ourselves to the advocacy role for which we are best positioned for our community, our patients and ourselves. 